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However, the relatively high failure rate of up to 40% underscores a strong clinical need for complementary treatment strategies, such as biomaterial augmentation. Herein, the first hydrogel biomaterial augmentation of USLS in a recently established rat model is described using an injectable fibrous hydrogel composite. Supramolecularly\u2010assembled hyaluronic acid (HA) hydrogel nanofibers encapsulated in a matrix metalloproteinase (MMP)\u2010degradable HA hydrogel create an injectable scaffold showing excellent biocompatibility and hemocompatibility. The hydrogel can be successfully delivered and localized to the suture sites of the USLS procedure, where it gradually degrades over six weeks. In situ mechanical testing 24 weeks post\u2010operative in the multiparous USLS rat model shows the ultimate load (load at failure) to be 1.70\u00a0\u00b1\u00a00.36\u00a0N for the intact uterosacral ligament (USL), 0.89\u00a0\u00b1\u00a00.28\u00a0N for the USLS repair, and 1.37\u00a0\u00b1\u00a00.31\u00a0N for the USLS + hydrogel (USLS+H) repair (\n                    <jats:italic>n<\/jats:italic>\n                    \u00a0=\u00a08). These results indicate that the hydrogel composite significantly improves load required for tissue failure compared to the standard USLS, even after the hydrogel degrades, and that this hydrogel\u2010based approach can potentially reduce the high failure rate associated with USLS procedures.\n                  <\/jats:p>","DOI":"10.1002\/adhm.202300086","type":"journal-article","created":{"date-parts":[[2023,5,23]],"date-time":"2023-05-23T21:00:15Z","timestamp":1684875615000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Supramolecular Fibrous Hydrogel Augmentation of Uterosacral Ligament Suspension for Treatment of Pelvic Organ Prolapse"],"prefix":"10.1002","volume":"12","author":[{"given":"Beverly","family":"Miller","sequence":"first","affiliation":[{"name":"Department of Chemical Engineering University of Virginia  Charlottesville VA 22903 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wiley","family":"Wolfe","sequence":"additional","affiliation":[{"name":"Scripps Institution of Oceanography University of California  San Diego La Jolla CA 92\u00a0093 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James L.","family":"Gentry","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering University of Virginia  Charlottesville VA 22\u00a0903 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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